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Since opening its doors over 15 years ago, Access Institute has been providing essential mental health services to low-income members of our community at our Hayes Valley clinic. One of the many aspects that makes our clinic unique is that clients have access to psychotherapists and psychiatrists under one roof. Sharing the same location benefits the clients, strengthens Access Institute’s training program, and facilitates a collaborative, multidisciplinary approach to treatment.

Access Institute’s 13 therapists work closely with our two psychiatrists, Julie Leavitt, M.D. and Sam Tucker, M.D., because they are thoroughly integrated into the program. The psychiatrists regularly conduct case conferences, provide trainings, and consult individually with the therapists. Such an environment facilitates and encourages collaboration between the therapists and psychiatrists, who effectively form a treatment team. The team is driven by a common goal – to help each client heal and thrive.

Julie Leavitt joined Access Institute when the organization was founded and has been involved in developing the model of patient care that is intensive, responsive, and depth-oriented. “I joined Access Institute fifteen years ago because I was very much interested in its model, which was a training program for mental health professionals that wanted to understand psychoanalytic treatment. And I was interested in it because it’s a low-fee community clinic. It gives me an opportunity to work with those who are marginalized in the community. I appreciate how Access Institute gives the therapists access to learn about people from other cultures and populations, and also gives people from marginalized populations access to care.”

Sam Tucker joined Access Institute about five years ago, but has been giving back to his community since the beginning of his career. While maintaining a private practice, he has worked part time at a number of agencies, including City Wide Case Management, French Hospital, and the geriatric ward at California Pacific Medical Center. He has also volunteered at Continuum, Tenderloin AIDS Resource Center, and Tenderloin Health. “I have always felt the need to give back,” said Sam. “From the get-go, I worked at least quarter time in a public setting. Psychotherapy and psychiatry is elitist in a way, and I don’t think that’s right. I think everyone should give back. Part of their career should be working with people who can’t afford the high cost of mental health treatment, whether it’s one morning or one day per week,” he said. “Volunteering here is part of my identity. There’s also a dearth of psychiatrists nationwide. It almost feels like a moral obligation to volunteer.”

I appreciate how Access Institute gives the therapists access to learn about people from other cultures and populations, and also gives people from marginalized populations access to care.” – Julie Leavitt, Access Institute Psychiatrist

Sam attributes the success of the collaboration between the psychiatrists and therapists at Access Institute to the mutual respect and understanding between them. “I know my boundaries. They’re doing psychoanalytic psychotherapy, which is exactly what I was trained in. Psychiatrists are now being trained just as psychopharmacologists, and unfortunately I don’t think that they understand psychotherapy, and how the two – medication and psychotherapy – can work together,” said Sam. While his role is to target and alleviate symptoms by medication intervention, the therapist’s role is to hold the patient more holistically and globally, he said. Julie shares the same view, explaining, “The therapists are the stewards of the treatment, and provide the holding environment for the treatment. They are in charge of overseeing the treatment, while we are the consultants.”

While their roles are different, the channels of communication between the therapists and psychiatrists at Access Institute are always open, which as Julie described, is “the hallmark of collaboration.” Part of that communication concerns the potential side effects of medications a client is taking. “The therapists need to stay informed about the medications their patients are taking in case there are untoward effects,” Sam reported.

The therapists and psychiatrists also have the benefit of easy access to each other for consultation, which facilitates a comprehensive, informed approach to treatment. “Sam and I invite the therapists to meet with us in person,” said Julie. “That can be helpful, not only to discuss the nuts and bolts of treatment, but also the psychodynamic information. That goes along with the philosophy of this clinic, which is unique in that it is psychodynamically oriented in terms of how we think about the patients and how we can work dynamically in a collaborative relationship.”

While the psychiatrists may determine that it is appropriate to prescribe medication after an evaluation, not all clients who are referred to Julie and Sam are prescribed medication. “A philosophy around psychiatric care is that it includes not just the prescription of medicines, but also the evaluation of a person’s situation,” Julie noted. “The psychiatric evaluation is helpful for gathering information, but it doesn’t necessarily mean the individual needs medication. It’s about doing a full diagnostic evaluation and considering how their struggles can be thought about in a systematized way. I help people understand they’re not abnormal -- they’re suffering. They’re suffering in ways that can be helped, and understood, not just with medications. I prescribe a lot of self-care. I prescribe better nutrition, socializing, getting outside and into nature, or making links with the outside world.”